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| Gallbladder perforation: A single-center experience in north India and a step-up approach for management |
| Vivek Gupta, Abhijit Chandra ∗, Vishal Gupta, Ravi Patel, Amit Dangi, Ajay Pai |
Department of Surgical Gastroenterology, King George’s Medical University, Lucknow, Uttar Pradesh 226003, India
∗ Corresponding author.
E-mail address: abhijitchandra@kgmcindia.edu (A. Chandra). |
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Abstract Background: Spontaneous gallbladder perforation (GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies.
Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018.
Results: We identified 151 patients (81 females and 70 males) with mean age of 53 years. Most common presenting features were pain (96.7%), fever (54.3%) and jaundice (31.1%). Most common cause was gall- bladder stones (84.8%) followed by common bile duct stones (30.5%), xanthogranulomatous cholecystitis (17.9%) and malignancy (11.9%). As per Niemeier classification, 8.6% had type 1 GBP (free perforation in peritoneal cavity), 76.2% had type 2 GBP (localized perforation) and 13.2% had type 3 GBP (cholecysto- enteric fistula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more com- mon in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients (72.2%). Seven patients (4.6%) had a postoperative morbidity of Clavien-Dindo III or higher. There were three mortalities in patients who underwent surgery.
Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.
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2022, Vol. 21 
